Active NPI
Sams East Inc
Doing business as Sam's Pharmacy 10-4998
- Community/Retail Pharmacy
- The Villages, FL
National Provider Identifier
1942445168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PH23840
- Legal business name
- SAMS EAST INC
- Doing business as
- Sam's Pharmacy 10-4998
- Practice address
- 755 N Hwy 27/441
The Villages, FL 32159 - Phone
- (352) 751-5989
- NPI assigned
- Dec 3, 2008
- Last updated
- Aug 30, 2023
- Organization subpart
- Yes
- Parent organization
- WAL-MART STORES INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Laura Levine
- Title
- MGR of Government Contracting
- Phone
- (479) 204-8550
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | PH23840 | FL | Primary |
Addresses
Primary practice location
755 N Hwy 27/441
The Villages, FL 32159
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Phone (479) 277-1238
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000697200 | Medicaid | FL | |
| 2118205 | Other | PK |
Other names 1
- Sam's Pharmacy 10-4998
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930034671 | FL | DME Supplier - Pharmacy | 7012038581 | Practice locations: Lady Lake, FL |
National Provider Directory
National Provider Directory- Part of
- Walmart Pharmacy 10-206
Member of 2
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Sams Pharmacy 10-6254
- Community/Retail Pharmacy
- Maple Grove, MN
- NPI 1184641581
Member Of
-
dba Walmart Pharmacy 10-1588
- Community/Retail Pharmacy
- Victorville, CA
- NPI 1043237456
Member Of
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228262400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1693353600000",
"number": "1942445168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "702 SW 8TH ST",
"city": "BENTONVILLE",
"state": "AR",
"postal_code": "727160445",
"telephone_number": "479-277-1238",
"fax_number": "479-277-4331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "755 N HWY 27/441",
"city": "THE VILLAGES",
"state": "FL",
"postal_code": "32159",
"telephone_number": "352-751-5989"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SAMS EAST INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WAL-MART STORES INC",
"enumeration_date": "2008-12-03",
"last_updated": "2023-08-30",
"certification_date": "2023-08-30",
"status": "A",
"authorized_official_last_name": "LEVINE",
"authorized_official_first_name": "LAURA",
"authorized_official_title_or_position": "MGR OF GOVERNMENT CONTRACTING",
"authorized_official_telephone_number": "479-204-8550"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "FL",
"license": "PH23840",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000697200",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2118205",
"state": null
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.3.667.2",
"affiliationName": "Ability Network",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "100 N 6th St # A",
"city": "Minneapolis",
"state": "MN",
"country_code": "US",
"postal_code": "554031505",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "Sam's Pharmacy 10-4998",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Sam's Pharmacy 10-4998",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in The Villages, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.